Pharmacy Update for All Anti-Obesity GLP-1s under ESP

The changes in this bulletin apply to all groups that use OptumRx

Similar to the changes recently made to Zepbound, it has been brought to our attention that members on plans that do NOT include weight loss medications were unable to fully utilize manufacturer copay assistance cards for the drug Wegovy. This was due to discounts from the “Enhanced Savings Program” (ESP)   

In order to allow members access to the maximum dollar amount allowed by the manufacturer copay card, we are removing Wegovy from the “ESP” discount program retroactively effective July 1, 2024. 

This is considered a positive change for members taking Wegovy as the discounts at the point of sale were providing less overall savings to the member than the manufacturer copay card assistance would allow. 

Saxenda does not currently have a manufacturer copay card available, however due to confusion when using member look-up tools, we are electing to remove Saxenda from the ESP as well for consistency across this drug category.

Member Questions

Why are Wegovy and/or Saxenda no longer “covered”? 

Your Wegovy and/or Saxenda prescription were processing through a discount program. This was not a “covered” medication under your plan benefit, but rather received a small discount from the retail price. Because of this discount, members were not able to utilize manufacturer copay assistance cards to their full extent. We have removed the discount to allow the maximum savings offered by the manufacturer to our members.

Does using the manufacturer copay card contribute to my deductible or out-of-pocket maximum?

No, this will not contribute or satisfy any deductible or out-of-pocket accumulators, as this is not part of a “covered” benefit. This was also true when filled under the discount programs.

What if I do not want to use the copay card? Can I still get a discount?

Because using the manufacturer copay card will result in significant savings for the entire affected membership compared to the previous discount, we are not able to apply the discount for individual members. We recommend getting a manufacturer copay assistance card. (See steps to register for a card below)

I do not have a manufacturer copay card. How do I get one?

Go to https://www.zepbound.lilly.com/coverage-savings or https://www.wegovy.com/coverage-and-savings/save-on-wegovy.html and follow the steps to register for a manufacturer copay assistance card. Manufacturer coverage terms and conditions apply. Details are listed on the website. (Member should verify benefits with plan sponsor)

Are any other weight-loss medications in the current ESP/Lifestyle programs being removed?

Currently, Zepbound, Wegovy, and Saxenda are the only medications that have been removed from the ESP discount program due to how the manufacturer copay assistance cards are structured. Current other non-GLP1 weight loss medications are still eligible for the ESP program discount at the pharmacy point of sale. 

**This information does NOT apply to plans with opt-in Weight Loss Medication inclusion coverage**